From a holistic standpoint a hospital admission was recommended. This would facilitate stabilizing the patient from a medical standpoint and connecting patient with different services that can offer support.
Talk to patient and try to see what the problem is/or was that precipitated current situation. Obtain fetal heart-beat. Get a ‘thumb nail’ mental status evaluation and full medical history.
Start a peripheral IV and attach her to monitors.
Screen carefully for pre-eclampsia: Serial BP checks. Check urine for protein (300mg +). Check for peripheral edema and/or facial edema. Indications already present
Monitor blood glucose q 6 hours until WNL. {NB a blood sugar over 400 leads to ‘spilling’ sugar into urine, which in turn would cause further electrolyte imbalance}. IV saline/glucose and insulin pump as indicated (and/ fast acting and Lente insulin titrated to blood glucose).
Na and K must also be monitored to check return to WNL.(Osmotic pressure can cause loss of electrolytes in urine - along with the glucose).
The patient’s blood pressure must be monitored and, if appropriate, hypertensive medication used. Mg…etc. Blood Presssure should be kept below 140/90.
The Hemoglobin A1C is also raised and this would imply her blood sugar levels have been elevated for a sustained period of time. A dietician could help the patient outline a dietary plan for the pregnancy which would address blood glucose levels and appropriate weight gain.
Fetal ultrasound should also be checked (for a base line for fetal size and volume of amniotic fluid).
Psychological / psychiatric assessment is essential as the issue of neglect of other children must be considered. This issue is compounded by her recent unemployed status, financial stress, living with her Mother - in a small apartment - and her divorce. Important to establish which adults are ‘in the picture’ and their roles. The fact that she is coming for her initial OB/GYN visit at 21 weeks could suggest the patient is struggling emotionally and mentally.
Insurance advisors can help her with a return to a program or her eligibility for assistance (financial) - especially as the patient is a pregnant diabetic.
Social Services can advise patient about the status of the child custody issues.
ONGOING
Monitor patient for S/S anemia and pre-eclampsia and appropriate glucose and weight levels.
Discharge when stable.
Advise F/S , QID.
Patient should (minimally) be seen 2 x week.
Well I am struggling with navigation etc but will call someone to find out . . .
For now will post under patient profile
Jo
Hi ladies. I love what everyone has come up with so far, but in looking at the other group's pages I have come to realize I led you all in the wrong direction. Apparently everything we come up with and change has to be done through the link on the health assessment wiki...not the one I created. When you go to the health assessment wiki page you'll see all the groups listed on the right hand side, when you click on group one that's where all our work is to be displayed. I will move everything to that page. I'm sorry ;(
Hello~ The labs were seperated but when I went to save it, they all bunched together can anyone help! Audrey
Hello~ Just added some info feel free to change what you feel needs to be altered. Audrey
Hi all,
continued to add information on our patient. Dawn
All
I added info under 'Pregnant Diabetic Page'. Please add/alter as you wish.
I like the idea of unstable diabetic etc.
Jo :)
Hello~ I agree Jo, I think we should make our patient have some issues to make it interesting. How does an unstable, overweight diabetic with an unplanned pregnancy sound? I think by making her a more complicated case the more information we can include or is that to much? Audrey
Hi Audrey and Karen Welcome Audrey! I think the fact you are posting means you're good to go. What do you think Karen?
I am posting a brief interview (and will talk more) about interview with Doctor. We need to expand her profile a bit: 1. Is she a stable diabetic? 2.What is her current weight? 3.Is this a planned pregnancy? 4. Other social issues/problems?
Let's get creative :)
Best - Jo
Helllo~ The page looks great! I received the email that I am not a member however the page says that I am. Can anyone explain? Should we start assigning portions of health information? ~Audrey
I hope that you all can find this page, so that we can start developing our patient, and commence discussion on interviews and such. If you look to your right you will see links one that says home, and the other that says Patient 1 Pregnant Diabetic. If you click on the second link I started a page where we can begin inputting data about our patient. I figure we can use the home page for general communication. Let me know what you think so far.
Hi all, I have taken it upon myself to start our page. Once you have become a member, you will be able to change and edit things as you see fit. I figured we could start by brainstorming about our Wiki's name. Hope you like the design layout I chose, if not feel free to make any changes. I wanted our logo to be a pregnant shadow or picture, but if you find something that will work better, let me know. Thanks, KB
Hi All,
Our Page looks great. I believe I'm all set to get started. Dawn
Hi Karen So good to chat yesterday. Thank you again for starting this page and the picture is really wonderful. Off to interview Doc. now and will try to create a new page with his interview . . . . Hello to all in Group 1. Looking forward to chatting.
Well Hello again to all in Group 1. I am about to write up a quick overview of my chat with the Doctor and perhaps add a link that pertains to the piece. Jo
Best - Jo. . .
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From a holistic standpoint a hospital admission was recommended.
This would facilitate stabilizing the patient from a medical standpoint and connecting patient with different services that can offer support.
ONGOING
Well I am struggling with navigation etc but will call someone to find out . . .
For now will post under patient profile
Jo
Hi ladies. I love what everyone has come up with so far, but in looking at the other group's pages I have come to realize I led you all in the wrong direction. Apparently everything we come up with and change has to be done through the link on the health assessment wiki...not the one I created. When you go to the health assessment wiki page you'll see all the groups listed on the right hand side, when you click on group one that's where all our work is to be displayed. I will move everything to that page. I'm sorry ;(
Hello~
The labs were seperated but when I went to save it, they all bunched together can anyone help!
Audrey
Hello~
Just added some info feel free to change what you feel needs to be altered.
Audrey
Hi all,
continued to add information on our patient. Dawn
All
I added info under 'Pregnant Diabetic Page'. Please add/alter as you wish.
I like the idea of unstable diabetic etc.
Jo :)
Hello~
I agree Jo, I think we should make our patient have some issues to make it interesting. How does an unstable, overweight diabetic with an unplanned pregnancy sound? I think by making her a more complicated case the more information we can include or is that to much?
Audrey
Hi Audrey and Karen
Welcome Audrey! I think the fact you are posting means you're good to go. What do you think Karen?
I am posting a brief interview (and will talk more) about interview with Doctor.
We need to expand her profile a bit:
1. Is she a stable diabetic?
2.What is her current weight?
3.Is this a planned pregnancy?
4. Other social issues/problems?
Let's get creative :)
Best - Jo
Helllo~
The page looks great! I received the email that I am not a member however the page says that I am. Can anyone explain? Should we start assigning portions of health information?
~Audrey
I hope that you all can find this page, so that we can start developing our patient, and commence discussion on interviews and such. If you look to your right you will see links one that says home, and the other that says Patient 1 Pregnant Diabetic. If you click on the second link I started a page where we can begin inputting data about our patient. I figure we can use the home page for general communication. Let me know what you think so far.
Hi all, I have taken it upon myself to start our page. Once you have become a member, you will be able to change and edit things as you see fit. I figured we could start by brainstorming about our Wiki's name. Hope you like the design layout I chose, if not feel free to make any changes. I wanted our logo to be a pregnant shadow or picture, but if you find something that will work better, let me know. Thanks, KB
Hi All,
Our Page looks great. I believe I'm all set to get started. Dawn
Hi Karen
So good to chat yesterday. Thank you again for starting this page and the picture is really wonderful. Off to interview Doc. now and will try to create a new page with his interview . . . .
Hello to all in Group 1. Looking forward to chatting.
Well Hello again to all in Group 1. I am about to write up a quick overview of my chat with the Doctor and perhaps add a link that pertains to the piece.
Jo
Best - Jo. . .
Welcome to Your New Wiki!
Getting Started
Need Help?